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Age: 35

Sex: Female

Indication: Pregnant patient with vaginal bleeding

LMP: 6 weeks prior

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Case #36


Findings

  • A single intrauterine gestational sac is identified in the lower uterine segment, which contains a fetal pole with cardiac contractions
  • Mean sac diameter = 5.5 mm, which corresponds to a calculated gestational age of 6 weeks, 2 days
  • Heart rate = 190 beats/minute
  • Heterogeneous material within the endometrial canal
  • Heterogeneous myometrial echotexture
  • Cervix appears closed
  • Probable corpus luteum in the left ovary with an otherwise normal appearance of the ovaries
  • Small volume free fluid in the cul-de-sac


Diagnosis

Spontaneous abortion in progress

Sample Report

Single live intrauterine gestation with estimated gestational age of 6 weeks, 2 days by mean sac diameter. However, the position of the gestational sac in the lower uterine segment and presence of heterogeneous material likely representing hemorrhage in the endometrial canal raise concern for spontaneous abortion in progress. The cervix currently appears closed. Recommend attention to serial quantitative beta-hCG measurements and consideration of repeat ultrasound if clinically indicated.

Heterogeneous myometrial echotexture, suggestive of adenomyosis.

Probable corpus luteum in the left ovary with an otherwise normal appearance of the ovaries.

Small volume free fluid in the cul-de-sac.


Discussion

  • The major differential consideration for spontaneous abortion in progress is lower uterine (including C-section scar) or cervical ectopic pregnancy
  • Unlike ectopic pregnancy, the gestational sac should migrate distally on followup ultrasound and beta-hCG values should begin to decrease
  • If there is a previous ultrasound showing location of the gestational sac closer to the uterine fundus, then this is usually a straightforward diagnosis



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